From here to there: promises and perils in scaling up health adaptation

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Objective: document lessons learned and identify opportunities and barriers to scaling up health adaptation projects in low- and middle-income countries to address current and future climate variability and change

Data sources: evaluation reports and other materials covering the first five years of implementation (2008-2013) of three multinational health adaptation projects covering fourteen countries (Albania, Barbados, Bhutan, China, Fiji, Jordan, Kazakhstan, Kenya, Kyrgyzstan, Macedonia, Philippines Russia, Tajikistan, and Uzbekistan) and qualitative data collected through a focus group consultation and interviews with 19 key informants purposively selected for their expertise and role in health adaptation to climate change

Methods: a qualitative review and synthesis of documents for evidence and examples of: attaining objectives and planned results of interventions; sustainability; stakeholder participation and community engagement; country ownership and socio-political constraints; human resources and capabilities; replicability and scalability; and health adaptation monitoring and evaluation

Main conclusions: The national projects increased resilience for particular weather-sensitive health outcomes by focusing on incremental improvements in policies and programs to address the current adaptation deficit associated with climate variability, and by beginning to establish enabling environments for additional adaptation. Irrespective of resource constraints, low and middle-income countries need to prepare for climate change through better understanding of potential risks, strengthening health systems, ensuring adequate policies and legislation, facilitating institutional support, and public education and awareness programs, including disaster preparedness measures. However, no project planned nor considered how to scale up successful community-based activities. Further, the activities undertaken may not be sufficient to address significant increases in climate variability and change. National health plans and budget processes need to move beyond focusing on shorter-term activities to address climate variability to also promoting mitigation and to transforming adaptation policies and programs into multi-faceted, collaborative (multi-disciplinary), and iterative activities, with support for capacity building, knowledge communication, and institutionalized monitoring and evaluation.

Climate change impact on heat-related mortality under some RCP scenario

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Background: In 2014, we reported the future heat-related excess mortality projections as Chapter 2 of the book by World Health Organization. In this projection, we used SRES A1B scenario and the target was elderly population, i.e., 65+ years. We updated the projection using RCP scenario and for all age groups combined.

Methods: We defined excess mortality identical to the WHO book: The relation between daily maximum temperature and mortality is V-shaped, and the temperature at which the mortality is lowest is called "optimum temperature (=OT)." When the temperature is higher than OT, the mortality risk is higher than that at OT. We define this difference between the mortality at higher temperature and that at OT as excess mortality.

For projection, we used RCPs 2.6, 4.5, 6.0 and 8.5 with SSPs 1, 2 and 3 Target periods were 1981-2000 as the baseline, 2020s, 2050s and 2080s. The general circulation models (=GCMs) we used are GFDL-ESM2M, HadGEM2-ES, IPSL-CM5A, MIROC-ESM-CHEM and Noresm1-M. As of now, RCP&SSP-specific mortality rate has not been publicly available. Thus, we calculated mortality using IIASA SSP-specific population data by country, sex and 5-yaer age category.

Results: Regardless the GCM, excess mortality increased along with the time, and large increase was observed in China, India and Europe. Along with the temperature rise, the increase in excess mortality varied with the GCM, but the difference was smaller for nearer future. The difference due to the SSP appeared smaller compared with the difference due to the model.

Discussion: Impact of climate change on heat-related excess mortality will occur not only developing countries but also developed countries. This is specific to heat-related mortality, unlike other major health impacts such as malnutrition, malaria, dengue fever, diarrhea and deaths due to coastal floods. Although "autonomous adaptation," i.e., optimum temperature becomes higher along with the warming climate without specific adaptation policy, would occur, this ubiquitous impact all over the globe would require us to take actions for mitigation and adaptation.

Conclusion: Heat-related excess mortality would affect both developing and developed countries, and shows a good example of the necessity of cooperation all over the world.

Acknowledgements: This study was supported by the Environment Research and Technology Development Fund (S8 & S10) of the Ministry of the Environment, Japan, and the Global Research Laboratory (grant K21004000001-10A0500-00710) through the National Research Foundation of Korea (NRF), funded by the Ministry of Education, Science, and Technology, Korea.

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Climate change is likely to affect human health with important differences by world region. As climate change is likely to affect proximal and distal (upstream) risk factors for a wide range of health outcomes, the quantification of these risks and burdens is complex, and few global models are available. We will report the finding of a global assessment of the impact of climate change on selected mortality outcomes undertaken for the World Health Organization.

Future cause-specific mortality in 2030 and 2050 (in the absence of climate change) was estimated using regression methods for three development futures: base case, high growth and no-growth scenarios. Global climate-health models were developed for a range of health outcomes known to be sensitive to climate change: heat-related mortality in elderly people, mortality associated with coastal flooding, mortality associated with diarrhoeal disease in children aged under 15 years, malaria population at risk and mortality, dengue population at risk and mortality, undernutrition (stunting) and associated mortality. Future climate change was characterized by a medium-high emissions scenario (A1b) run through three climate models. The counterfactual was a future world with population growth and economic development but with baseline (1961–1990) climate. The annual burden of mortality due to climate change was estimated for world regions. For most pathways considered, the results reflect both positive and negative impacts on health.

Compared with a future without climate change, the following additional deaths are projected for the year 2030: 38 000 due to heat exposure in elderly people, 48 000 due to diarrhoea, 60 000 due to malaria, and 95 000 due to childhood undernutrition. WHO projects a dramatic decline in child mortality, and this is reflected in declining climate change impacts from child malnutrition and diarrhoeal disease between 2030 and 2050. On the other hand, by the 2050s, deaths related to heat exposure (less than 100 000 per year) are projected to increase. Impacts are greatest under a low economic growth scenario because of higher rates of mortality projected in low- and middle-income countries. By 2050, impacts of climate change on mortality are projected to be greatest in south Asia. These results indicate that climate change will have a significant impact on child health by the 2030s.

A main limitation of this assessment is the inability of current models to account for major pathways of potential health impact, such as the effects of economic damage, major heatwave events, river flooding and water scarcity. The assessment also did not consider the impacts of climate change on human security. Current models can capture only a subset of potential causal pathways, and none account for the effects of major discontinuities in climatic, social or ecological conditions.

Global climate change is projected to have substantial adverse impacts on future mortality, even considering only a subset of the expected health effects, and under optimistic scenarios of future socioeconomic development and with adaptation. This indicates that avoiding climate-sensitive health risks is an additional reason to mitigate climate change. The results indicate that significant impacts of climate change cannot be avoided, and supports the case for strengthening programmes to address health risks including undernutrition, diarrhoea, vector-borne disease, and heat extremes, and for including consideration of climate variability and change within programme design. The strong effect of socioeconomic development on the projections of future risks emphasizes the need to ensure that economic growth, climate policies and health programmes particularly benefit the poorest and most vulnerable populations.

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H. Bambrick (1) ; S. Moncada (2) (1) University of Western Sydney, School of medicine, Sydney, Australia; (2) University of Malta, Institute for european studies, Msida, Malta

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In coming years, the Pacific is expected to experience increasing climate extremes as periods of drought and heavy rainfall, cyclones and heat become more frequent and intense, oceans become warmer and more acidic, and sea-level rise affects artesian water causing flooding. Pacific Island communities are especially susceptible to the health impacts of climate change due to their isolation, limited land area, low lying topography, and generally high levels of inherent vulnerability, together with poverty and widespread reliance on subsistence farming. The poorest communities especially are inadequately resourced to manage current climate and health risks, and have even less capacity to prepare for and adapt to long-term climatic changes. Despite the acceptance that communities in the Pacific are highly vulnerable, very little is known about how these risks may best be managed with so few resources and the structural disadvantages typical of small island developing states. Existing data in the region relevant to climate and health is sparse, may not be relevant to particular communities, and may miss important local features. This study is an in-depth assessment of vulnerability on Rabi Island. We document current health concerns, especially in relation to climate-relevant health risks. We evaluate contemporary coping mechanisms and capacity for adaptation, in order to develop feasible and acceptable strategies in the context of extremely limited resources.

Rabi Island is a small volcanic island in Fiji situated to the east of Vanua Levu, one of Fiji’s two main islands. Rabi is home to around 5000 Banaba Islanders who were brought there from Kiribati 70 years ago, displaced by phosphate mining on their home island. The islanders have maintained their Banaba culture and language and have dual Kiribati-Fijian citizenship. In many ways, Rabi is typical of Pacific vulnerability to climate change – underlying poor health, poverty and exposure to extreme events such as cyclones – but with the added complexity of being an ethnic minority population that is especially isolated from the rest of the country. Income is very low, houses are crowded, and islanders rely on fishing and subsistence farming. Aside from coconuts that are collected for processing, there is a single cash-crop, kava, that generates most of the income on the island. Vector-borne disease, food- and water-borne and other communicable diseases, ciguatera (fish poisoning), malnutrition and direct physical trauma during extreme events are current health problems. Existing climate vulnerabilities, including threats to food security, are likely to be amplified with climate change.

We present the findings from our vulnerability assessment using data from a detailed random household survey (156 item questionnaire, 200 households, yielding data on 1500 individuals) and from focus groups of women and men in each village using Participatory Rural Appraisal methods. We explore locally feasible opportunities to boost community resilience in the face of climate change and adaptation interventions to minimise adverse health outcomes. We discuss the relevance of our findings to other vulnerable communities in the Pacific and elsewhere.